would be, of and she couldn't con team operate that arthur would have -- [inaudible] he and jackson are unmoved, and so the clock keeps ticking. you can watch this and other programs online at booktv.org. coming up booktv presents after words an hour-long program where we invite guest hosts to interview authors. this week in his book "unaccountable" he provides an inside look at hospital errors. over treatment, and the closed-door culture that protects million prak -- he -- richard davis. ..

. over my career i've got answers like the parking here is good or we can do better than that. this is one fits almost of the u.s. economy and competition just seems to be at the wrong level and patients are frustrated. another reason i wrote the book is that doctors are getting crushed right now. they have got declining medicare payments. they have got increasing

overhead, hospitals have more expenses. malpractice rates are going up. the burnout rate is 46% and doctors are getting crushed right now and i just felt like we needed a voice out there and it's okay to talk to the general public. >> host: so you make the point that medical mistakes for the third leading cause of death in the united states. that is a shocking figure. can you talk a little bit about that? >> guest: it was shocking even for me as someone interested in the skill and quality to put it in that way. medical mistakes. we kill as many people from medical mistakes as we do from car accidents and other three, four and five causes in the u.s.. i guess i've never really thought of it that way because we don't really talk as openly and honestly about mistakes as we showed in our profession, to be very blunt. think about number one heart disease. the number one cause of death in

the u.s.. we spend a heck of a lot of time and energy on hard prevention and heart disease. cancer, a lot of money going to cancer. we are just now beginning to recognize that this is number three and some people have told me, after i wrote "unaccountable" there is not really a medical mistake problem in the u.s. and i think we are starting to to just now accept that this is something we have got to start talking honestly about. >> host: so, we know that there is tremendous care that is received here in the u.s. and certainly at the institution that you trained at but this concept of kind of equality and disparity of quality. you got interested in it during her doctoral program at harvard. can you talk a little bit about how you came into that and what your interest was in really where did the field come from? >> guest: well, i think it

just started to be recognized as a field when i was a student. it was sort of a right time, right place kind of thing. i had this frustrating experience with a patient of mine that i was assigned to follow. her name was missed his tanks and she is in the opening of the book. she really didn't want anything done for her cancer which had spread all over. the doctors clearly wanted to do something. they essentially bullied her or talked her into it. they overstated the benefits and understated the risks, something we know from research happens especially those of us to do procedures. it just didn't seem right to me. it seemed as if the profession wasn't telling the truth. it seemed as if the profession of medicine had long strayed from its original mention -- vision. it's not why went into medicine and its why i quite frankly quick. i started school and public health where i met david gates

who -- >> host: i'm sorry to interrupt. so you were in medical school and you have decided you had had enough and you went to the school of public health? >> guest: i basically explained what mrs. bankston wanted. the they torme upside down for explaining this to them, that she didn't want the procedure done and they basically implied, didn't matter what she wants. this is what she needs and this was to me a sign of a culture that i had observed from the outside but didn't want to be apart of and i quit medical school. then i started graduate school for public health because i heard of a track three could focus on quality and there were people now interested in medical mistakes. the first time they were describing studies were they were looking at handwriting resulting in patient harm and it was a radical concept at the time. david bates put a big study out

and he describes the head of one of the largest doctors organizations in the united states calling him and basically saying, what are you doing this for? this is not a problem. i realize that realized that we have had these explosions of knowledge in medicine but we have not coordinated care and all the services that we have end up having so many cracks that the cracks are as harmful as the diseases that we are treating and you have got to step back and ask, you know, are we hurting people overall on a global level? what are we doing sometimes and of course now we have got this reports saying, 30% of everything we do may not be necessary health care. when we step back, 30% of all the medications we prescribed and the tests we order and the procedures. this is something i think which is, for the first time, really

being called out as a problem. people out there in the general public have been saying for a long time, we don't like the closed-door culture of medicine. we find medicine even sometimes to be an arrogant industry. we feel like we don't connect. i remember in medical school being told that a nosebleed is at at the status. i citizen than a nosebleed? what else could at the stacks as the? it's like a whole different vocabulary. and that disconnect has a think created an issue with our trust in the public and this issue of overtreatment now has further strained the public trust that medicine has. it's a great job and it's a great profession. you are in health health healthe and everyday you see folks have tremendous results, the byproduct of phenomenal advances in technology and the art of medicine with compassion. it is a great profession that when we have got the institute

of medicine saying 30% of the time we miss the mark, we have got to study this. we have got to make it a discipline of science and say how can we look at this like we look at cancer? where are the cracks? where the mistakes? that was the main reason i decided to go down this path. >> host: that statistic of 30% in quality, waste and variability is a stunning statistic. why do you think that, and you mentioned culture a little while ago. what is it about the culture of health care, where those types of activities have been allowed to go on for such a length of time. if you look at any other industry, 30% waste or 30% error rate really would be unacceptable. how does that occur within health care? >> you know it's a great

wondered why people tolerate 30% waste and health care but they wouldn't tolerated in any other industry. i saw a statistic recently in a report, the average income of an american in the united states gone up about 30% over the last decade. the increase in health care costs that they are paying have gone up about 68% over the same time period. essentially we have offset the increases in income with increased health care costs so you wonder why is it that we tolerate this? i have talked to business leaders who say you know, every contractor we pay we have some metric of how well they perform except for one, health health c. we keep throwing money added and patients say the same thing with their premiums and their new high deductibles. we keep throwing money at it. what more are we getting for our money? there has been this culture of medicine that has respected the art of individual autonomy, but

at the great risk that some best practices never get standardized. in my own field, pancreas auto transplant where we take a pancreas out of somebody, treat the cells and give the cells back to the patient. we need a laboratory to treat the cells. medicare at one point paid a bonus of 20,000-dollar payment to hospitals for doing this on top of what they were already charging. it became a very profitable business. we have a laboratory at johns hopkins in the operating room and we have the patient asleep under anesthesia, take a pancreas have intrigued the cells and give the cells back right then and there, same operation. hospitals across the country started doing this operation, taking the pancreas out but because they don't have a laboratory, put it into a cooler and send it by jet to another city, have it treated at another facility in another city or state, have it flown back and then cut the patient open up again for second operation.

why would anyone have that done? they just don't know about the other option. i'm not talking about hospitals. i'm talking about to the top 10 hospitals in the country do this. we have got smart people, good people working in a bad system where the financial incentives lure people to do things that just aren't right. i think if hospitals are accountable for their results the results and the patient satisfaction is scored in the patient outcomes and the complication rate, the volumes in the readmission rates, all the basic metrics in health care performance that doctors are endorsing as valid, they were available to the public, people could choose where to go based on who performs the best like any other free market works and like any other uses to reduce waste in their field. >> host: so the issue of patient choice about where they seek care and what has been out

there and certainly the health care literature and discussions amongst leaders for a number of years, where many people advocate that if indeed the patient had the opportunity to see the quality and see the individual physician, hospital infection rates etc. they would naturally gravitate to those institutions. there's another school of thought that says, you put all the information out there but that won't really happen and patients will naturally gravitate to it. you reference in referenced in your book where patients seek their care. i go there because my mother was born there or because it's two miles from my house. talk to me a little bit about the balance there and how if indeed all of the quality is a factor, how do we get patients informed as to how they can seek this information and will it make a difference and where they seek their care? >> guest: well you know i have

got some patience you tell me., whatever you want to do you just tell me and i will do it and they have total blind trust to the doctor in the system. baby for that, that's okay but more more patients now want to know the options and they want to know something can be done minimally evasive. if they really need to take the medication a medication or affairs a holistic or naturalistic or preventive means, maybe they can do physical therapy to avoid something. they want to know now. we have an informed public and increasingly we are seeing that. one critic of the book told me you know, if you put stuff out there people will never use it and it won't reduce health care ways. four weeks after the book came out, a study in the journal of the american medical association showed that when there was public reporting of heart procedures -- we are talking about stenson angiograms, the overall number of procedures went down by 14% and there was no difference in patient outcomes.

a big study, jama, four weeks after the book came out showing the public reporting reduces waste and has no impact. the patient did just as well. i think increasingly we are learning about the impact of public reporting and look, all of us know.there's this should not be practicing. one national conference i was at, they asked the audience how many of you know that doctor that shouldn't be practicing in every single hand went up. i think it's because we all recognize there is going to be some bad apples that are going to respond to financial incentives and there is little accountability in general and health care. the hospital seven miles down the street from my house had a doctor put in at least 500 unnecessary hearts fans. now, if those procedures would have been recorded and given to the patient on a thumb drive as

they advocate in the book in general, that doctor wouldn't have gotten away with putting in stems and arteries that were never even blocked. there would would have been some oversight like when we had speed traps with cameras at an intersection. everybody follows the law. in the compliance rate we are trying to get everyone to follow the speed limit and forget raids it's been horrific. since we have had automobiles would have been trying to do education. education doesn't work to get people to follow the speed limits. what works is when somebody sees a camera or an officer on the side of the road and then everybody is compliant. lean health care have a lot of room to increase accountability and quite frankly i think it'll really restore the trust that has been broken with the general public. >> host: so let's go back to the culture question again. i was riveted when i was reading the book about your account when you are a net room and everybody raised their hands. in fact as you describe it, you

were -- to raise your hand. there was a senior position next to you who looked at usaid really, you don't know anyone? but what about the culture do you think has led us to this point where we actually said -- where we no harm is occurring or we have a sense of it that we have gotten to this point where people are afraid to speak up and afraid to criticize their peers or the institution? you make a point a number of times in the book that, and actually in your opening chapter, where you talk about the fact that you know, go to where the people in health care, the nurses and the doctors and administrators at that hospital, where they would be. how is the culture proliferate what you have been talking about, or the public, how did they seek that information out?

>> guest: you know i once told a friend the best way to find out about the quality of a hospital is to ask an er nurse who works there. a nurse knows more about the quality of the hospital than probably anyone else there, and for that matter any industry, front-line worker, providing the services be it creating products probably knows more than any of the administrators of the institution about the culture. the reason is that culture drives everything we do. in economics there is this phrase, no one has ever washed a rented car. they don't own it so why would they? a sense of owning the delivery of care is a critical important element. that is what bothers me about sina statistics now, that 40% of.org zinni nida states are burned out according to mayo clinic. they did a study three weeks ago. when we have 46% of front-line

providers in any industry burned out, of course the quality is going to be poor and of course mistakes are going to happen and of course people are going to fall through the cracks. when people don't feel that they own the service -- code docs tell me when i go to conference is an speak, i often know how to health care -- make health care a better institution and i know out of care -- make the care safer for people but i don't feel empowered. that i think is one of the great divides right now in health care and united states. increasingly, we have some doctors saying in some facilities that there is a chasm between themselves and their unit manager, between themselves in those who are making the policies or those calling the shots on a national level. they don't feel empowered and we are seeing more variability because of that. >> host: you talk in your book about the administrative crack downs if you will, where you get

providers of care and senior administrative leaders working a little bit more together or getting the administrators out from their offices if you will. talk a little bit about that in what and what you see the value of that being as well as its impact if you will on the quality. >> guest: you know we all want the same thing. doctors, administrators, insurance companies, policymakers. there is an astronaut from outer space who was asked, what does the middle east look like from outer space? the astronaut said you know there are no lines when you look at it. the lines are man-made and that is what is going on in health care. the lines we have made in health care or man-made. we don't want the same good for the public. we have got good people. there it is sometimes working in this artificial system. we tell administrators, make a

profit, billiar beds so they make a profit and they fill the beds. we tell doctors to see more patients so they see more patients. everyone seems like they are doing their job but as don burke said it's like the jobs are designed wrong and we have good people. when my dad was a practicing doctor at sizing or hospital, i remember this administrator named ken ackerman who would come down and sit down with a doctor, walked down the hallway, prop himself right in their office and say, how's it going? what do you need to do your job better? he was not a doctor, ken ackerman but the doctors on the staff said that he was the administrator in a white coat. that is how he got the nickname. he was in touch with the front-line providers. you see it in a kind of industries, be at lehman brothers, be it large corp.

delivering a service that is multinational. when the administrators lose touch with the front-line folks, that is when bad things start to happen and that is when the accountability becomes a problem because there is no transparency and that was really the impetus for writing "unaccountable." >> guest: as a hospital president and my struck by the fact that if you want to know where the issues are ugoda the front-line and you go to the operating rooms. but why do you think that we, and many hospitals, perhaps there has been a separate differentiation are defied if you will between administration, doctors, and does it have anything to do with incentives. we talked a little earlier about this so what do you think?

>> guest: i have seen both extremes in the united states and the talk about both extremes in the book. i recently learned an emergency room that was built that was freestanding with no hospital attached to it. can you imagine if you had a heart attack and you go to the emergency room and they don't have a hospital to put u.n.? they have two ship you across a floating bridge across a lake the lake to go to another hospital because that is their associate hospital that they admit patients in. in in the united states this happens and you see these doctors saying this is an right and even sometimes administrators will say we know it's not rational but that is the way we get paid. and you realize when things are disassociated the care gets very dangerous. then you see times when they are in harmony. you see when there is transparency of infection data and how the administrators talk

to individual provider specifically about infections and what do we need to do to get our infections down? this is a model of management for any industry. in the new york transparency experiment when heart surgery outcomes were publicly reported, i tell a story that mark chesson described where they actually had administrators walking to the unit and asked the doctors and nurses, what do we need to do to get our mortality down? they are asking nurses, how can we decrease at? you don't see that level of common mission around complications except when everything is aligned and there's transparency of data and accountability at all levels for the performance for people who on the system. i remember hearing the story of a nurse saying we have never seen a ceo here in the cardiac icu except when we had public reporting of heart surgery

outcomes. you realize these are old-fashioned concepts and these are american concepts. they are not public art -- -- republican or democratic. transparency is american value. we expected at the white house, we expected of congress, we expected up wall street. sarbanes-oxley will have a ceo go to jail if they misreport their earnings for a company. health care is almost like an island. it's almost as if you can misreport infections and there is not that level of transparency and we treated differently. we have to start treating health care like we do any other business to reduce the waste and reduce the cost for everyday americans. people are getting crushed right now. they are essentially paying for all of their health care with the exception of catastrophic care. it's becoming a two-tiered quest -- system. we see primary care doctors now say, pay us a couple thousand dollars a year and we are going to take care of you with

housecalls. you have my cell phone. call me at night. its medicine the way they like to practice it and the way we have alternative practicing medicine. is how the patience of a lace trimmed of getting it and they are revolting against this year craddock regulatory system that involves siding with insurance companies and all the hassles that doctors are getting crushed with lately. >> host: let's talk a little bit about leadership and the role that leadership plays. i loved the story do you tell about al brodie and i use that story myself. talk a little bit about that and the role and the example as well of that story and what you think it means to senior leaders in health care? >> guest: you know, i find that many times everybody wants the same thing but there is sort of a break down of communication.

when bill brody walked through the icu and started talking to nurses -- >> host: tell the audience who bill brody was. >> guest: he was was a part of this initiative to have all the executives adopt the unit and many of of the executives at hopkins adopted the unit, and icu or warder clinic or operating room area and they would meet with the staff, and we still do. they would say what are the safety concerns here? how are you going to harm the next patient? they anticipate what's going to go wrong the next time with a medical catastrophe and let's face it they happen every year and every hospital in the country. it doesn't matter if it's the best are the worse. they have medical mishaps every year. these discussions create sort of in anticipation that allows people to redesign and manage the hospital system to make it safer and you know the employees, the staff and the nurses feel valued. they feel like people listen to

them and when we have got 46% of doctors saying they are burned out and they don't field value and they are getting crushed with this insurance and having to fight with insurance coverage, value goes a long way and not feeling valued by your hospital is a serious way to alienate the very people that are responsible for safety and creating a safe culture. >> host: so, for those of us who our leaders are ceos of hospitals etc., what role should accountability and transparency play in the way that we conduct our daily business? what is your perception of that? where can we improve? >> guest: it seems like it's the old guard of establishment or if you will, the corporation they resist a little transparency but when you talk to the individuals or the

people, the moms, the parents, those who take care of patients, these are all people who are also hospital administrators and they want the best and they understand the value of its. they are smart people. they are pushing this and we are seeing this transparency revolution not driven by patients ironically that driven by the doctors and administrators and organizations that see the waste in health care. it bothers the heck out of them and they want to do something about it. we are seeing surgeons, organizations, all these organizations rallying together to save you know we think it's the right thing to do to be transparent about what we do. we are proud of our results. we have got nothing to hide and if we perform well the public should see it and if we don't the public should see it anyway because we are honest and transparent. i once ordered a c.a.t. scan on

the patient and it got done on the wrong patient. as soon as i learned about this i ran to the patient's bedside and i said, i'm sorry, you didn't get your c.a.t. scan because there was a mistake and i want to make sure we get it done right away. to the other patient i say, we are sorry we got a c.a.t. scan that was intended for someone else and it was a mistake. i am sorry and i will share the results with you. the patients were not angry like i thought they would be. they looked at me with a sense of appreciation. thank you for being honest with me, doctor. i feel like patience a lot of times just want honesty and they want to be treated with dignity. they want to be treated like they would in any other business and that's what people are hungry for in health care and that is what the organizations and leaders in health care are saying that we need to provide to patients. we did a study recently that looked at the number of national databases follow hospital

performances and patient outcome. in my old field of pancreas transplantation there were databases we report our outcomes to. there is a national pancreas pilot transplant registry that follow all the outcomes but the public has no access to the information. in our research study we found there are over 200 national registries that attract hospital outcomes in only three make their data available to the public. most are funded a taxpayer dollars. i think we as a society are starting to ask the question, do we have a right to know about the quality of our hospitals and i think we are seeing leaders step up and say, yes we do. >> host: you have raised some provocative and compelling issues and your book really has i think then truly illustrative

in terms of the things that are going on. "the new york times" bestseller list etc.. i'm interested to know the comments of your peers both perhaps younger physicians, older physicians and you have said old guard a couple of times. you put this out and you talked about this. many people are recognizing it. talk a little bit about what impact it has had in how people are feeling from the feedback? >> guest: i've gotten thousands of letters many of which are handwritten. tens of thousands of e-mails that say you know, my mom died because of a medical mistake and we didn't feel we really were a party to the process. we didn't feel we were given all of our options. we think there is a mistake or we know there is a mistake.

thank you for sharing the story. is almost as if everybody had a story. i have personal accounts here of people i know orem close to have suffered from medical mistakes. everyone it seems like -- it almost seems like we all know somebody and i think there is this general appreciation for talking about this openly and honestly. younger doctors in particular come from a different generation. medical students nowadays have very little power for not telling the in any aspect of life. they insist on transparency and do it in all aspects. and then there are what i referred to as the old guard, those that say i'm an expert in medical mistakes. we shouldn't be talking about this with the general public, or there was one individual who

responds to the book who says there was a typo on the inside jacket of the cover. 30% of health care is unnecessary in the response is, there's a type of? medical mistakes are the number three cause of death and their responses there was a type of? of course there is going to be response. look at the way the politicians have divided the country and polarize the subject. health care is complex. the reality is there are good ideas on both sides of the aisle. i think we need to talk about common sense solutions to health care. all the different ideas we hear about policies are really centered on how to pay for health care differently, how to fund the broken system. we don't just have to talk now about how to finance the broken system. effect to move move on to how tx the broken system.

i think that is a fundamental discussion, transparency, patient outcome, patient empowerment. i have lived in d.c. for a while and i know politicians are not going to fix health care permanent way. we doctors are going to do it and insurance companies are not going to do. it's going to be the patients and we have to give them good information. 60% of new yorkers looking up a track record in ratings before they go there, why do they have to walk in for their health care blind about what a hospital c-section rate is or infection raider bounce back rate or how many operations they do or how many knee operations they do. if you want to go to a hospital that you are the only case in five years that they they have scenery do you want to go to a hospital that treats 50 cases a year? these are basic things the public demands in any industry and i think we can provide this

through more transparency. >> host: that leads me to -- you use the term reckless health care in your book. talk a little bit about that, your thoughts around how that plays into what you just described. we have 70% of new yorkers who will go on line and look at the restaurants but they will just walk down the street to their hospital without any due diligence. how does the fred flintstone care in the culture if you will of medicine play into that? >> guest: i am constantly flabbergasted about how patients will walk into a doctor's office and the doctor will not mention the superior option to the patient. i think sometimes it's because they're worried about losing the patient to another doctor.

we pay a lot of money based on quantity of what we do. that's got to change. we have got to be paid based on quality and our outcomes. we have got to get away from this heavy volume oriented way that we finance our health care system which causes people to a retreat. when we have doctors in the survey why is this treatment epidemic so broad they say because we are so heavily incentivized, usually they don't say themselves, the other doctors are heavily incentivized or there is malpractice concerns and other things. they have the answers but a lot of the doctors out there having answers on how to address this problem, but i hear doctors almost every week that say i'm getting text messages and e-mails from my superiors to do more operations and i feel like i'm doing the right thing for my patient and i'm doing all that i can. they don't like that. that's not the type of medicine

and not the type are or professionally went into. i think we need to start thinking about how patients can get the best options by eliminating these heavy incentives, under referred. there are patients that i met as a resident that were not told that there's a superior way to reconstruct a after a removal because the local plastic surgeons don't do it that way. they do it another way. the research in the literature clearly show its superior. is still the standard of care and they are not going to get sued for doing it that there but there are these wide variations. in my own field of pancreas surgery, do you know the small pancreas as the needs to be removed in the tale of the pancreas, the patient walks into one hospital or one doctor's office and they will have a big midline incision have the tale of their pancreas removed and their spleen. they walk into another doctor's office and they will have a

small minimally invasive keyhole incision and have the tale of the pancreas removed and not remove the spleen. removing or not removing an oregon based on which door you walk into comedies are all good hospitals and good hospitals with good reputations. removing it colin. they're two different ways of doing it, minimally invasive and an open incision in some say you can do it either way. we have a "new england journal of medicine" study that's over 10 years older shows a minimally invasive is better and it's common sense that it's better but there is a the wild west of medicine that only half of the patients that need minimally invasive we'll ever have it done that way. >> host: you use the term the wild west of medicine and elsewhere in your book you talk about the need to have a new sheriff in town.

so, talk to me a little bit about this concept of the new sheriff in town or a con ability or holding people responsible and how that balances with what we frequently hear when we try and move forward with standardization or accountability as an artform and medicine. out of those two things kind of play out? >> guest: i get the artform of medicine. most of the patients that come to see me our complicated pancreas tumors, my own area of expertise and in my own field they see these complex stages where patients are told there's there is nothing that can be done and then they come to me and we say yes, it's high-risk. we will take it on. these are the risks and if you want to go for it we will go for it. and doctors were right for a long time i think to say wait a minute, we can't make our outcome be transparent. doesn't properly adjust to the

high-risk nature of the cases we take on here. i agree 100%. as a matter of fact doctors were right to lead the opposition to transparency. for simply make the raw data transparent, we could punish doctors to take on the noble high-risk cases and reward those who discriminate against them. it would actually create the reverse incentive now the doctors are saying we have got valid ways toward better quality. we have created these measures. we have endorsed them. we monitor them with their own national registry housed by the doctors group. we think it's the right time to make this available to the public and for the first time ever, this is an exciting time in health care and with transparency. we have got consumer reports now partnering with doctors groups to make the national registry outcome available to an easy to understand ways that the patient can look up with an app with the

risk adjusted performances at the heart surgery center in their community. this is i-4 think the future of health care. it's an exciting time. it's a revolution. i have sort of become an observer if you will or a reporter on the subject. i'm not the leader of the transparency revolution health care is a matter fact, we don't have one leader. this is something we believe in and are as passionate about as the art of medicine. >> host: so you talk about where perhaps a decade or more ago, doctors protected that information because it was misinterpretedmisinterpreted, if you will. then there has been this evolution of thought towards transparency, partnership between the consumer groups and physicians. if that is the case, what impact has that had in terms of our overall levels of quality,

safety efficiency? this movement has been going on for sometime some time yet you cite some really challenging cases and statistics that are going on. what is your sense of how things have moved and where's it going in the future? >> guest: is a great point. we have gotten burned with transparency. we have had systems that are local and small. the patients haven't known where to get the information. let's face it, unless there's a central site like hospital safety score.org run by leapfrog or the consumer reports cite, there is no sort of master dashboard. we are not really informing the public and were not really guiding them. the other thing is a lot of times we have created so many loopholes that we doctors have learned how to game the system and that is what happened in new york with the heart surgery program. we saw for for the first-time

ceos and doctors focus on a common mission to reduce certain complications in surgery. the ceos were saying here, how about a dedicated anesthesiologist who specializes in hard anesthesiology and the doctors said yes, that is what we need. there's a tremendous teamwork in solid transparency but the system was not perfect. for the first time now i think we are seeing the doctors groups better define what is a complication. they are using independent nurses at a hospital to track the outcomes. early versions we would just ask the surgeon, what is your infection rate? well of course we would understate our publication rate -- complication rate. it was a uniform bias, the nature of assessing your own performance. i think now there is an exciting opportunity. we have got organizations with doctors lined up to say, look at all the sites that we can

populate with information. the affordable care act tried to push some of this forward. i believe there is a lot more we need to push forward. its readmissions now that will be available for the public and for the first time this year people can look up a hospital's infection rate on the master site hospital care.gov. for the first time they'll be able to look at a hospital bounce back or readmission rate, the number of people that have come right back to the er. these are what doctors generally considered to be valid, not perfect, valid ways to measure quality. i think were going to see consumers rally around them. they are not perfect and we will have to make them better. we have to refine them, revise them and make them more risk-adjusted but there's a tremendous time right now out there. quite frankly we need fresh ideas in health care. we have been talking about the same stuff for years. >> host: in the field of

quality in health care, it's a relatively young field if you will. you talked about the need for patients and consumers to get actively involved in fact you reference that doctors cannot do it. regulators can do it and politicians can do it but that the patients have to do it. talk a little bit more if you will about the role that patients need to have. today i'm struck with the fact that a five google something on the internet, a certain disease or a treatment, i will get hundreds, perhaps thousands of different sites to go to. one thing i have been hearing from patience is they have difficulty navigating that. how could they know what the high-quality data that is out there is. you reference the couple but if we are going to ask patients and consumers to play an active role and help us move forward and change the system, how do they

navigate that? what is their role within that? ..

>> that we have many moving parts and players where people are responsible with little accountability. what is the role of teamwork that we deliver? what is the role of the patient within that?

how do we move forward with physicians, regulators, pati ents? >> everybody seems to recognize t market is part of high quality care but we haven't measured it for a long time. if there is one part of the assembly line that is so shoddy it is a reliable but yet it hurts the entire process but nobody looks into it. there is a survey that measures the quality to ask every day providers would you go here for your own care? do you feel comfortable to speak up? are you part of 15? are your concerns heard? it turns out these concerns are followed by just not available to the public.

the government issues the survey on their website as a free download. it collects but there is accountability -- no accountability. but doctors and nurses will say when the team work is good everybody is happy. vendors turnover rate is low, they feel they own the care better, a better place to work. with mine near mess i described the book when i harmed a patient from a mistake that i made in day almost operated and the nurse spoke up that is a save the patient having the

of wrong side procedure. the day was crazy busy going back-and-forth with the ico the team dropped the patient and they prep to the wrong side but had catastrophic consequences. then realized it is a team sport. more and more nurses say with the surgery boards and to have disruptive behavior of the last three months. and lot of it starts with the respective your leaders 87 so the work that you did

so i am struck by the examples list the members of the team and you describe boyd in your book. what past have been for that to become more common? with the operating room equated to what happened to fly a plane where aviation went through for the is decades ago. how was that the market and? >> it is one of the cultural trains it needs to

change -- trains in need to change faster. like the military. the rules and procedures the rules to do things and the under in standards to never go above our superiors head. we could be more honest and open of health care to design the way that we talk in the clinic and in the hospital. when we do about -- develop the checklists for the operating room, to have a daily goal sheets and then to popularize the who group represented our experience and it is much bigger than we ever anticipated. but the first item going over the name and the

members of further the -- of the team's roles. a simple introduction. and we also the value to make introductions a simple statement of your name and what role that you have. as a critical part to empower people-speak up again. empower people to sit around for a meeting to present something it is easier to speak up again. the first time your activated. so the team members are activated. >>host: what about the

patient? do they speak up? >>guest: absolutely. as they add to our understanding but by and large if you can join a family member, go with them. this program called open notes that patients can instantly see the doctor's note to during a visit has been tremendously successful. it will not fix health care. innovation will not solve the health care crisis. but there is enthusiasm because of what represents. the profession bridging the divide to say you are a part of this.

even add a line at the bottom to say i a agree. i misspoke. as part of the patients record. one patient with the domino pain she asked a question there is a certain type of been in jerry's ice cream cause this type of pain? by a told her it wasn't related. then she had a suspicion she was sorry i wrote to in the chart. i said here it is. the the bond of trust was restored. >>host: a couple minutes left. talk about leaders, but clinicians, what role does the board of trustees of

hospitals have? there's a movement to get them involved. >>guest: i was disappointed when i saw the department of hhs a physician should be on the board. they overturned the intended rule at the last minute. that was a great disappointment. hospital boards and a good ones are focused on the outcome to look at the performance hospitals do well and the board does a great service. but then the culture becomes

bad. >>host: this book has had a tremendous impact. you have had a lot of press. will you keep operating? what your plans? >> there is nothing better to say your mom will be fine. but i love to talk about the subject from this position at hopkins. >> speaking at different meetings. >>host: to write another book? >>guest: hopefully. >>host: the book is "unaccountable" and dr. marty makary thank you for being with us today.